Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA)
Collaboration

INTRODUCTION: HIV care and treatment programmes worldwide are
transforming as they push to deliver universal access to
essential prevention, care and treatment services to persons
living with HIV and their communities. The characteristics and
capacity of these HIV programmes affect patient outcomes and
quality of care. Despite the importance of ensuring optimal
outcomes, few studies have addressed the capacity of HIV
programmes to deliver comprehensive care. We sought to describe
such capacity in HIV programmes in seven regions worldwide.
METHODS: Staff from 128 sites in 41 countries participating in
the International epidemiologic Databases to Evaluate AIDS
completed a site survey from 2009 to 2010, including sites in
the Asia-Pacific region (n=20), Latin America and the Caribbean
(n=7), North America (n=7), Central Africa (n=12), East Africa
(n=51), Southern Africa (n=16) and West Africa (n=15). We
computed a measure of the comprehensiveness of care based on
seven World Health Organization-recommended essential HIV
services. RESULTS: Most sites reported serving urban (61%;
region range (rr): 33-100%) and both adult and paediatric
populations (77%; rr: 29-96%). Only 45% of HIV clinics that
reported treating children had paediatricians on staff. As for
the seven essential services, survey respondents reported that
CD4+ cell count testing was available to all but one site, while
tuberculosis (TB) screening and community outreach services were
available in 80 and 72%, respectively. The remaining four
essential services - nutritional support (82%), combination
antiretroviral therapy adherence support (88%), prevention of
mother-to-child transmission (PMTCT) (94%) and other prevention
and clinical management services (97%) - were uniformly
available. Approximately half (46%) of sites reported offering
all seven services. Newer sites and sites in settings with low
rankings on the UN Human Development Index (HDI), especially
those in the President's Emergency Plan for AIDS Relief focus
countries, tended to offer a more comprehensive array of
essential services. HIV care programme characteristics and
comprehensiveness varied according to the number of years the
site had been in operation and the HDI of the site setting, with
more recently established clinics in low-HDI settings reporting
a more comprehensive array of available services. Survey
respondents frequently identified contact tracing of patients,
patient outreach, nutritional counselling, onsite viral load
testing, universal TB screening and the provision of isoniazid
preventive therapy as unavailable services. CONCLUSIONS: This
study serves as a baseline for on-going monitoring of the
evolution of care delivery over time and lays the groundwork for
evaluating HIV treatment outcomes in relation to site capacity
for comprehensive care.